Periodontal Maintenance

         Periodontal maintenance is the step in a perio treatment plan meant for maintaining someone who has established a renewed/healthy periodontium. I wasn’t sure what it was until hearing Dr. Stevens explain it. A patient with perio problems, namely generalized deep pockets, will undergo Phase 1 treatment (Scaling and Root Planing). The patient will then return for a Phase 1 Eval. The phase 1 eval is basically the same thing as perio maintenance, but it occurs at a different time of a patient’s treatment plan.

         If the phase 1 eval shows that many deep pockets still exist, then Phase 2 treatment (some type of surgery) is necessary. . . Once phase 2 is complete and the patient has been evaluated and deemed to have a healthy periodontium (under those circumstances at least), then the patient is put on perio maintenance. Forced to come back every 3 months, just to make sure their periodontium remains relatively healthy. Understanding this process will help answer questions Dr. Stevens may have.

The Starting Check

                Dr. Stevens will ask you questions. Probably lots of them depending on how confident you sound/his mood/whatever. MAKE SURE that you know everything about your patient before going up to get your starting check. You not only should know your patient’s medical history, but you should also know their entire perio history.

      Why are they even here? They are in Perio maintenance so they obviously were diagnosed with perio disease and at least had to go through phase 1 treatment and phase 1 eval. So some things you need to be aware of: 

1. What was the original problem? Look at their Perio worksheet and initial probing depths to figure out why they were admitted into perio treatment. 
2.  Did they ever have a Phase 1 Eval? 
1. It happens. A patient that I am seeing next week had scaling and root planing, but there is no evidence of a follow up evaluation. Now they are in perio maintenance and haven’t even had probing depths recorded since the very first visit. So make sure you know what phase of treatment the patient is in . . . or what they are actually supposed to be in.

The Exam

The perio faculty are looking for a couple of things from the exam:

1. Probing depths 
1.  It is okay if your PD’s don’t match up exactly with ones from the previous exam. Remember, it’s all students recording this stuff. Who is to say they are right and you are wrong? The most important thing is to make sure your depths are consistent. Check a couple of spots more than once if you’re really worried about inaccurate depths.
2. Gingival Recession 
3.  Bleeding on Probing 
4.  Plaque Index 
5.  Occlusion 
1.  Dr. Stevens may ask about the occlusion. Try to at least record the overbite and overjet and what classification they are.

What Comes Next?

                If your perio exam reveals that the patient still has generalized deep pockets, then perio maintenance is NOT where they need to be. Perio Maintenance will not do them any good because you don’t solve the issue of deep pockets. 

           So according to Dr. Stevens, if you find that they still have generalized deep pockets, you need to work them up a new treatment plan. Depending on how long it has been since they have had Phase 1 treatment, your treatment plan may consist of more scaling and root planing, or possibly even Phase 2 treatment. The patient I was helping with had not had any treatment in about a year, so Stevens suggested more scaling and root planing to start off. 

           If your patient has deep pockets, you will NOT proceed with a prophy. You can do it if you want to, but as Lauren mentioned, they will be returning soon for SC/RP and insurance won’t cover both, so don’t code for it or whatever. You will just write up a Tx plan, show it to your coordinator, discuss it with the patient, get their approval, and then make sure they get another appointment.

          If their probing depths look good, then you can proceed with a prophy and then tell them to come back in 3 months. 

Wham Bam,

Joe